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A communique on the National Dialogue on the Sustainability of   Essential Health services in Uganda

 

Introduction

The Economic Policy Research Centre (EPRC) in collaboration with UNICEF held a Public Dialogue on the National Budget 2020/21 on 20th February 2020 at the Golf Course Hotel, Kampala. This year’s Budget dialogue was based on theme "Sustainability of Financing for Essential Health Services". This theme was partly informed by the vision embedded in the new National Development Plan (NDP-III) which targets to achieve universal health coverage through expanding access to health care services to lower local government levels, whilst increasing access to affordable medicine and health supplies.

The  Public Dialogue brought together the various stakeholders both in the  Public, private and NGO sectors to examine ways through which essential health services, as well as other key child and adolescent focused interventions can be financed in a more systematic and sustainable manner. This communique briefly gives the highlights of the proceedings of the Dialogue as indicated below

  1. Welcome remarks from Dr. Diego Angemi- Chief of Social Policy and Advocacy,UNICEF

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  • He expressed his appreciation to the EPRC and UNICEF teams for organizing a robust dialogue to discuss Sustainability of Financing the essential services in Uganda.
  • Pointed out increased funding for vaccines (UGX 21) Billion in FY 2019/20 as one of the notable achievements of the previous Budget dialogue in 2019.
  • He also underscored the need for Government to prioritise investment in Health Sector adding that it is key to unlocking the Country’s demographic dividend.
  1. Presentation by Dr. Ibrahim Kasirye, Director Research, EPRC

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  • The presentation was entitled ‘Investing in Health sector in 2020/21’ and highlighted the achievements allocations to the Health sector programmes in the FY2020/21
  • Kasirye indicated that the Health sector allocation in the FY 2020/21 accounts for 5.1% a significant reduction from 7.9% in FY 2019/2020 owing to a reduction in external support.
  • He indicated that in the FY 2020/21, Government would cut funding to most of Health Sector programmes with the exception of allocation to Referral hospitals and policy and Planning.
  • In conclusion, he indicated the need for Government to; address service delivery constraints at decentralised level, strengthen the referral systems to ensure better health services and effectively track the off budget commitments
  1. Panel Discussion

The panel discussion consisted of 4 experts that discussed differently the theme based on their experience  

  1. Keneth Mugambe, Director Budget, MoFPED
  • Mugambe s.pngHe acknowledged the need to put more resources into the health sector and revealed that the revised Budget allocation  share to the Health sector is 8% of the total allocation not 5.1% as earlier indicated in the budget framework paper 2020/21
  • He also indicated the need for micro-analysis of the Health sector if we are to get a better view of what needs to change rather than focus on the macro analysis which just looks at the sector allocations.
  • He identified to the need to do micro analysis/in-depth of the Health sector to critically identify bottle necks in the entire health system supply chain like drug theft, expiry dates, leakages and poor services delivery at local governments
  • Notwithstanding the Health sector challenges, he indicated Government commitment to the sector evidenced by increased funding for Drugs through National Medical Stores, enhanced staff salaries among others
  • He emphasized the need to leverage Public Private Partnerships (PPPs) in health promotion programmes for example Faith based organisations can run campaigns on hand washing and good sanitation

 

  1. Clara Mira- The IMF Country Representative, Uganda

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  • She implored the government to ensure efficient use of the available resources in the health sector
  • She indicated the need to strike a balance in investment between physical and human capital infrastructure in order to harness Uganda’s demographic dividend
  • Emphasized the need to adopt an integrated financing approach to increase the fiscal space for the health sector. The strategy entails mobilising health sector resources from all possible stakeholders the private sector, Government, NGOs and Faith Based organisations among others.
  • She noted that regulation of external borrowing is key to enable Government expand its fiscal space for social spending and human capital development
  •  Dr.Tim .png
  • Dr Timothy Musila, Senior Health Planner, Ministry of Health
  • He indicated that a monitoring tool has been developed by the MoH to track the effective utilisation and accountability  of the financial resources allocated to the Health sector
  • He pointed the need to check the demand for health care given a high population growth and noted that this has limited the sustainability of service delivery. He therefore emphasized the need for population growth control measures like family planning
  • He emphasized the need to invest in prevention measures alongside the treatment measures to improve  peoples’ welfare  and prevent diseases as a whole 
  • Dr Viorica Berdaga, Chief of Child Survival and Development, UNICEF
  • Viorica S.pngShe indicated that there is limited funding for the children health.
  • Much as other health indicators like maternal and infant mortality have significantly improved, child malnutrition and death remain stagnant calling for more funding
  • Also emphasized the role of disease prevention rather than treatment adding that 60% of the diseases can be prevented by good hygiene like washing hands and proper nutrition
  • She indicated the need to monitor and track the use of off budget funding from the Development partners
  • She indicated that there is no domestic budget allocation to nutrition and emphasized the need to create a nutrition budget.
  • She noted that Ministry of Health should take on the medium and long-term planning while addressing sustainability of financing the sector
  1. Plenary session

The plenary discussion rotated around the following issues;

  1. Health Insurance

Participants indicated the need for Government to fast track the implementation of the National Health care insurance scheme to improved access of quality health care and protecting households from catastrophic spending.

  1. Public private partnership Involvement

Government needs to incentivize the Private sector and NGOs to attract more funding to the health sector in an effort to supplement the public funding to the sector. Participants indicated the need for Ministry of Health to initiate PPPs in nutrition and health promotion programmes. 

  1. Accountability of the Health sector resources

The participants stressed the need for efficiency to ensure that the available resources in the Health sector are managed well to enhance health outputs. Among other issues raised, included need to leverage the bigger allocations to the accountability sector to monitor the health service delivery. For instance there are reported cases that Government drugs are stolen from hospitals and sold in Private clinics and in other countries like DRC, South Sudan and Tanzania

  1. Increasing the Health sector Allocation

 Participants indicated lack of commitment by the Government to fulfil the Abuja declaration of allocating 15% of the National budget allocation to Health sector adding that the allocation has stagnated below 10% for the last 10 years. Further, the stakeholders called for more funding in health programmes that include; Herbal medicine research, health promotion, health lifestyle research and revitalising the training curriculum of health workers.

Way forward and emerging issues

  • There is need to engage MOH, MoFPED on allocating funding on nutrition programmes for the population especially for the Children
  • Need to curb the population growth rate through family planning methods and awareness campaigns especially in the rural areas
  • Leverage the accountability sector to ensure proper monitoring and accountability at all levels of health service delivery
  • Regulate external borrowing to widen fiscal space for health sector financing
  • There is need to develop an exit strategy to ensure health sector financing when donors withdraw funding from the sector
  • Increase funding for Non-communicable diseases like Cancer
  • Multisectoral coordination and Investment  in Children nutrition to prevent malnutrition
  • Fast-track the implementation of the National Health insurance scheme
  • Digitalization of the health service delivery systems
  • There is need to bring the private sector on board to interest them in health financing
  • Twin objective of improving efficiency and increasing funding

 

 

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